LS2 Integumentary

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LS2 Integumentary
2011-05-19 20:05:38
Life Span integument LPN RTW

care of patients with integumentary disorders, includes A&P review
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  1. Epidermis
    outer layer of skin that consists of an outer dead portion, and an inner, living cellular portion
  2. Stratum Germinativum
    Only layer of epidermis (inner) able to undergo cell division and reproduce itself.
  3. Diffusion
    process by which the stratum germinativum gets its nutrition and blood supply, enabling it to repair itself
  4. Stratum Corneum
    outermost layer of epidermis

    consists of dead cells that have been filled with a protein called keratin, making them dry, tough, and somewhat waterproof
  5. Melanocytes
    specialized cells that release melanin
  6. Melanin
    black or dark brown pigment occuring naturally in the hair, skin, iris, and choroid of the eye

    responsible for color of skin
  7. Freckles
    irregular patches of concentrations of melanin
  8. Dermis
    aka corium and true skin

    contains glands and hair follicles, thickest in palms and soles, filled with interstitual fluid
  9. Collagen
    gives stregnth to the dermis layer
  10. Papillae
    small fingerlike projections that project into the lower epidermal layer, without it, the epidermal layer would not be able to survive
  11. Subcutaneous Layer
    aka superficial fascia

    layer beneath dermis, connects skin to muscle, composed of adipose tissue and loose connective tissue, provides shape and contour

    Stores water and fat, insulates the body, protects organs, provides a pathway for nerves and blood vessles
  12. Sudoriferous glands
    sweat glands

    excrete sweat, which contains water, salt, urea, uric acid, ammonia, sugar, lactic acid, and ascorbic acid
  13. Ceruminous glands
    modified sudoriferous glands, secrete cerumen

    located in external ear canal
  14. Cerumen
    waxlike substance, protects the ear canal from foreign substances.
  15. Sebaceous glands
    secretes sebum through hair follicles
  16. Sebum
    lubricates the skin and hair, inhibits bacteria growth
  17. Lunula
    part of the root of a nail, exposed and looks like a white crescent
  18. Arrector pili
    muscle tissue surrounding the hair follice, contracts due to cold, or fight or flight response causing piloerection or "gooseflesh"
  19. Pruritus
    symptom of itching
  20. Clubbing
    broadening of the fingertips, indicates decreased oxygen
  21. PQRST
    • P-Provative/Palliative
    • what provokes/helps the condition
    • Q-Quality/Quantity
    • characteristics of the skin/how many
    • R-Region
    • S-Severity of signs and symptoms
    • T-Time its been present
  22. Macule
    flat, round, less than 1 cm in diameter

    ex: freckles, flat moles (nevi), petechiae, measles, scarlet fever
  23. Papule
    elevated, firm, less than 1 cm in diameter

    ex: wart (verruca), elevated moles, lichen planus
  24. Patch
    flat, nonpalpable, irregularly shaped macule more than 1 cm in diameter

    ex: vitiligo, port-wine stains, mongolian spots, cafe-au-lait spot
  25. Plaque
    elevated, firm, rough lesion with flat top surface greater than 1 cm in diameter

    ex: psoriasis, seborrheic and actinic keratoses
  26. Wheal
    elevated irregularly shaped area of cutaneous edema; solid, transient; variable diameter

    ex: insect bite, urticaria, allergic reaction
  27. Nodule
    elevated, firm lesion; deeper in dermis than papule, 1 to 2 cm diameter

    ex: erythema nodosum, lipomas
  28. Tumor
    elevated and solid lesion, greater than 2 cm

    ex: neoplasms, benign tumor, lipoma, hemangioma
  29. Vesicle
    elevated, superficial, not into dermis, fillied with serous fluid; less than 1 cm diameter

    ex: varicella (chicken pox), herpes zoster (shingles)
  30. Bulla
    vesicle greater than 1 cm in diameter

    ex: blister, pemphigus bulgaris
  31. Pustule
    elevated, superficial lesion, similar to vesicle but filled with purulent fluid (pus)

    ex: impetigo, acne
  32. Cyst
    elevated, encapsulated lesion, in dermis or subq layer, filled with liquid or semisolid material

    ex: sebaceous cyst, cystic acne
  33. Telangiectasia
    fine, irregular red lines produced by capillary dilation

    ex: telangiectasia in rosacea
  34. Scales
    heaped-up keratinized cells; flaky skin, irregular, thick or thin, dry or oily, variation in size

    ex: flaking of skin with seborrheic dermatitis following scarlet fever, flaking of skin following drug reaction, dry skin
  35. Lichenification
    rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation, often involves flexor (joint) surface of extremity

    ex: chronic dermatitis
  36. keloid
    irregularly shaped, elevated, preogessively enlarging scar; grows beyond boundaries of wound; caused by excessive collagen formation during healing

    ex: keloid formation following surgery
  37. Scar
    thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis

    ex: healed wound or surgical incision
  38. Excoriation
    loss of epidermis; linear hollowed-out crusted area

    ex: abrasion or scratch, scabies
  39. Fissure
    linear crack or break from the epidermis to dermis; may be moist or dry

    ex: athletes foot, cracks at corner of mouth
  40. Erosion
    loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla

    ex: varicella, variola after rupture
  41. Ulcer
    loss of epidermis and dermis; concave, varies in size

    ex: pressure sores, stasis ulcers
  42. Crust
    dried serum, blood, or pus; slightly elevated

    ex: scab on avrasion, eczema
  43. Atrophy
    thinning of skin surface and loss of skin markings; skin translucent and paperlike

    ex: striae, aged skin
  44. ABCDE
    • A-is the mole Asymmetrical?
    • B-are the Borders irregular?
    • C-is the Color uneven or irregular?
    • D-has the Diameter of the growth changed recently?
    • E-has the surface area become Elevated?
  45. Areas to assess baseline skin color
    palm, sole of feet, underside of forearms, abdomen, and buttocks
  46. Areas to assess pallor
    mucous membranes, lips, nailbeds, and conjunctivae of the lower eyelids
  47. What to check for skin inflammation and rashes in dark skinned patients
    palpate for warmth and induration
  48. Symptoms and transimission of Herpes simplex
    • caused by herpesvirus hominis
    • Symptoms seen in both types: fatigue, pruritus, burning pain, exudate after lesions rupture, usually present 2-3 weeks, most painful during 1st week

    Type 1: most common, causes common cold sore, associated with febrile conditions. no cure; usually occurs during acute illness/infection

    Type 2: causes lesions in genital area, known as genital herpes, flu like symptoms occur 3-4 days after vesicles erupt (headache, myalgia (muscle pain), fever, anorexia)

    Transmission: direct contact with open lesion, in type 2, primarily by sexual contact
  49. Treatment of Herpes simplex
    acyclovir (Zovirax)

    antiviral that alters course of the disease
  50. Nursing Interventions for Herpes simplex
    warm compresses to relieve pain and pruritis, keep lesions dry and avoid direct contact, analgesics, teach proper skin care and medical asepsis, and more
  51. Symptoms of Herpes Zoster

    causes spinal ganglia, rash generally in thoracic region following a peripheral nerve pathway, pain is burning and knife-like, tenderness and pruritus in affected area

    greatest risk occurs during weakened immune system
  52. Medical treatment of Herpes Zoster
    shingles: anagesics, often times opioid analgesics, steroids or corticosteriods for inflammation and edema, lotions for pruritus ( Kenalog, Lidex), oral and IV antiviral agent acyclovir (Zovirax)
  53. Nursing interventions for Herpes Zoster
    shingles: aimed at relieving pain pruritus, prevention of secondary complications, anxiety, teaching on controlling pain, applying meds and wet dressings, asepsis, preventing secondary infections, proper diet and vit C to promote healing